This is an article taken from Cosmetic Surgery Times.
Lifestyle Lift’s dirty little secret
September 10, 2009
Tag Archives: board certified plastic surgeon
In the current health care climate of diminishing reimbursements, more and more physicians are performing cosmetic surgery treatments and procedures. Unfortunately, many of these physicians are not plastic surgeons and have not undergone the same rigorous training as board-certified plastic surgeons. All patients should take certain steps prior to scheduling a consultation to ensure that their physician has the highest qualifications to perform cosmetic surgery.
- Ask if the doctor is a member of the American Society of Plastic Surgeons (ASPS). Membership in the ASPS ensures that the doctor is certified by the American Board of Plastic Surgery and meets requirements for ongoing continuing medical education.
- Confirm that the doctor is certified by the American Board of Plastic Surgery. Merely hearing that a doctor is board certified does not indicate which board has certified that doctor. There is only one board, the American Board of Plastic Surgery, that is recognized by the American Board of Medical Specialties to certify surgeons in the field of plastic surgery.
- Find out more about the surgeon’s specific hospital privileges. Although some procedures are commonly performed in an office or ambulatory surgical center, it is important to learn whether the surgeon has the same privileges in an accredited hospital. Hospital credentialing committees carefully evaluate a surgeon’s training and competency for specific procedures. If a surgeon performs a procedure in an office or surgical center, but does not have privileges to perform the same procedure in a hospital, it may be because he was deemed unqualified to perform that procedure.
Taking these steps before scheduling a consultation with a cosmetic surgeon will ensure that you find a plastic surgeon with the highest qualifications.
Many patients have asked if they can continue smoking up until their cosmetic surgery. The procedures most often in question are breast lifts (with or without implants), breast reductions, tummy tucks, and facelifts. Simply put, smoking and these surgeries can be recipes for disaster. Tobacco, nicotine, and carbon monoxide—key components of cigarettes—are proven to impede wound healing, making the stakes incredibly high for patients who smoke. Let’s delve into the risks and evidence, emphasizing why quitting smoking before surgery is not just advisable but crucial.
How Smoking Impairs Wound Healing
Smoking significantly affects the body’s ability to heal wounds. Nicotine constricts blood vessels, reducing blood flow to tissues. Carbon monoxide decreases oxygen levels in the blood, while tobacco’s toxic chemicals damage collagen and elastin, which are essential for skin strength and elasticity. Together, these factors severely impair the body’s capacity to recover after surgery.
In surgeries that involve lifting and tightening large amounts of skin, such as tummy tucks or facelifts, reduced blood flow can result in serious complications:
- Skin necrosis: A condition where the skin literally dies due to insufficient blood supply.
- Delayed wound healing: Prolonged recovery time increases the risk of infection and other complications.
- Dehiscence: This occurs when a wound reopens after being surgically closed, exposing underlying tissues.
- Infection: Poor oxygenation compromises the immune response, making smokers more susceptible to post-operative infections.
High-Risk Procedures for Smokers
Some cosmetic procedures pose greater risks for smokers due to the extensive skin manipulation involved. Here are examples of surgeries where smoking can have disastrous effects:
1. Facelifts (Rhytidectomy)
Facelifts involve tightening the skin and underlying tissues of the face to achieve a more youthful appearance. The skin’s blood supply is already reduced during this procedure due to the surgical lifting of the tissues. Smoking compounds this reduction, greatly increasing the risk of skin necrosis, especially around the incisions near the ears. Smokers are more likely to experience prolonged bruising, hematomas, and suboptimal scarring after facelifts.
2. Tummy Tucks (Abdominoplasty)
Tummy tucks involve removing excess skin and tightening abdominal muscles. This procedure disrupts a significant amount of blood supply to the abdominal skin, leaving it reliant on a network of smaller vessels to heal. Smokers face an elevated risk of wound dehiscence, infection, and skin necrosis. In extreme cases, large portions of the abdominal skin can turn black and die, requiring additional surgeries to address.
3. Breast Lifts and Reductions
Both breast lifts and reductions involve reshaping and lifting breast tissue while removing excess skin. Smoking dramatically increases the chances of nipple necrosis, where the nipple and surrounding areola lose blood supply and die. This catastrophic outcome often requires further reconstruction surgeries and can leave devastating scars.
4. Laser Skin Treatments
Even minimally invasive treatments like laser resurfacing can be affected by smoking. Smoking impairs the skin’s ability to regenerate and heal after laser treatments, leading to prolonged redness, irritation, and subpar results.
Evidence Supporting the Risks
Multiple studies have documented the dangers of smoking in surgical patients:
- A 2013 study published in Plastic and Reconstructive Surgery found that smokers are 2.5 times more likely to experience wound healing complications after surgery compared to non-smokers.
- Research in Annals of Plastic Surgery demonstrated a significant increase in the rate of skin necrosis in smokers undergoing facelifts, with complications as high as 12% in smokers versus 1% in non-smokers.
- A study on breast reduction surgery found that smokers were three times more likely to experience nipple necrosis than non-smokers.
Procedures Considered Safer for Smokers
Certain cosmetic procedures are considered somewhat safer for smokers, as they involve less extensive skin manipulation. These include:
- Rhinoplasty: The reshaping of the nose typically doesn’t require significant skin lifting.
- Liposuction: While it removes fat, it does not heavily impact the skin’s blood supply.
- Breast Augmentation: Implant placement involves less disruption to the skin’s vascularity.
Even so, smokers undergoing these surgeries are still at a higher risk of complications compared to non-smokers. Surgeons often provide strong warnings and disclaimers to ensure patients understand the risks.
Why Quitting Smoking is Critical
Because cosmetic surgery is elective, the goal is to minimize all potential risks. Quitting smoking even two to four weeks before surgery can significantly improve outcomes. Here’s how:
- Improved oxygenation: Increased oxygen levels enhance wound healing and immune function.
- Better blood flow: Nicotine-free blood vessels are more effective at delivering nutrients and removing waste from tissues.
- Reduced inflammation: Smoking cessation lowers systemic inflammation, which supports overall recovery.
Surgeons may also recommend quitting all nicotine products, including vaping and nicotine replacement therapies, as these can have similar effects on blood flow.
Conclusion: Choose Health Over Habit
The risks of smoking before cosmetic surgery are too significant to ignore. From facelifts to tummy tucks, the combination of smoking and extensive skin manipulation can lead to devastating complications, including skin necrosis, delayed healing, and infection. For those considering elective procedures, quitting smoking is not merely a recommendation but a vital step to ensure a safer surgery and optimal results.
If you’re planning cosmetic surgery and currently smoke, talk to your surgeon about strategies to quit. Your health, safety, and aesthetic outcomes depend on it.
Many of my patients ask how I choose the optimal size for a breast implant. Some women are very concerned about choosing too large of an implant, as they know this can make their breasts look unnatural. Other women worry that they won’t choose a large enough implant to see a discernible difference. To address these concerns, I use a variety of tools and techniques to help my patients select the best breast implant size:
Photos
Having patients bring photos of breasts they like and breasts they dislike helps me determine their goals. Visual references are invaluable in understanding each patient’s aesthetic preferences. Some women desire subtle enhancement, while others want a much more dramatic enlargement. By reviewing these photos together, I can better tailor my recommendations to their vision.
Measurements
Accurate measurements of the chest wall diameter, breast width, and breast height are crucial. These factors ensure the implant fits the patient’s anatomy. The breast skin envelope has natural limits; selecting an implant that is too large can cause it to sit too high, too low, or too far to the sides, resulting in an unnatural appearance. Taking precise measurements allows us to avoid these pitfalls and achieve balanced, proportionate results.
Trial Sizing
In-office trial sizing is a less valuable tool, having being largely replaced by 3D imaging. Although not an exact science, trying on different implants in a bra provides patients with a rough idea of how their new breasts might look in clothing. This exercise often sparks important conversations about their goals and helps patients feel more confident about their choices.
Conversation
Every implant has unique characteristics, including shape and profile, which significantly impact the final result. For example, a high-profile implant creates a different appearance compared to a moderate-profile implant, even if they are the same volume. Through open and thorough conversations during the preoperative consultation, I ensure that patients understand these differences and how they align with their desired outcomes.
3D Imaging with Crisalix
One of the most exciting advancements in breast augmentation planning is the use of 3D imaging technology like Crisalix. This powerful tool allows patients to visualize their potential results in real time. By uploading images of their body, Crisalix creates a virtual simulation of how different implant sizes and shapes would look on them. This technology takes much of the guesswork out of the decision-making process and provides patients with a clearer idea of their future appearance, helping them feel more confident in their choice. To schedule a 3D breast augmentation consultation using 3D imaging, begin the process by clicking here.
Intraoperative Sizing
Even with careful preoperative planning, intraoperative sizing plays a vital role. During surgery, I often use trial implants and sit the patient up to evaluate the breasts from multiple angles. This step is especially important for patients with breast asymmetry, as it allows me to make real-time adjustments to achieve the best possible symmetry and aesthetic result.
Combining Tools for the Best Outcome
Each of these tools serves a unique purpose, and together, they provide a comprehensive approach to selecting the optimal breast implant size. My goal is always to create results that are both beautiful and in harmony with the patient’s body. By combining measurements, imaging, trial sizing, and conversation, I can help patients achieve the look they’ve always wanted with confidence.
Almost all patients have several questions about the meaning of breast implant profiles. Patients have seen pictures on the Internet of patients with breast augmentation results they liked and wanted the same style implants as in the pictures. These patients had a limited understanding as to what breast implant profile refers, prompting this blog entry.
The naming for implant profiles predominantly refers to smooth, round implants, which are the most common type of implants used for cosmetic breast augmentation. The profile of the implant has nothing to do with the fill of an implant, with the vast majority of implants placed these days being cohesive silicone gel implants, otherwise known as “gummy bear” implants. The two major breast implant manufactures have different names for their implants. Allergan refers to its implants as low, low plus, moderate, full and high profile. Sientra has similar names, but also has a moderate profile plus implant, which is between its moderate and high profile implants. Motiva sticks with the same principles, but gets fancier with its names, referring to the implant profiles in the United States as mini, demi and full. In Europe, they offer an additional profile, Corse, which is the equivalent of an extra high profile implant.
The profile of an implant equates to the projection of that implant. For a given volume, the higher the profile, the fatter and narrower an implant is. As a result, higher profile implants tend to provide more fullness and a rounder appearance to the upper portions of the breast. Higher profile implants tend to be really useful in women with relatively narrow breasts who want significant enlargement of the breasts; in these women, if a low or moderate profile implant were selected, to achieve the desired volume may entail the implant riding into the underarm region. In contrast, a patient with a wider build or wider breasts may find that high profile implants may fail to adequately fill their entire breast; they often times benefit from implants with lesser projection. Higher profile implants also tend to be useful in women who desire a small breast lift without the incisions associated with a formal lift.
In recent years, there has been a notable shift in the preferences of patients seeking breast augmentation, with increasing interest in low-profile and low-profile-plus breast implants. These implants are characterized by a wider base diameter and less projection compared to high-profile implants. This design creates a more natural, subtle enhancement that aligns with the growing trend toward understated aesthetics. Many patients are prioritizing proportionate results that complement their natural body contours rather than opting for the more pronounced, rounder look traditionally associated with higher-profile implants.
The appeal of low-profile implants is also influenced by their suitability for specific body types. Women with broader chest walls often find that low-profile implants provide a harmonious fit that enhances their shape without looking artificial or out of proportion. Additionally, these implants are often favored by patients who wish to restore volume after pregnancy or weight loss while maintaining a soft, natural slope to the breast. As societal beauty standards continue to evolve, the demand for implants that achieve balanced, subtle results is expected to grow, making low-profile and low-profile-plus implants a significant choice in modern breast augmentation procedures.
Treatments with injectable fillers, such as Juvederm, Restylane, Radiesse, and Sculptra, not to mention others, can restore a youthful appearance to the lips, nasolabial folds, marionette lines, midface, jowls and lower eyelids, with minimal to no downtime. Many patients avoid these treatments, though, because they have heard horror stories from friends or colleagues about the pain associated with these treatments. Suffice it to say, this needn’t be the case – there are steps your plastic surgeon can take to make these treatments more comfortable.
Recently, BioForm Medical, Inc., makers of Radiesse, received approval from the Food and Drug Administration to mix the filler with lidocaine, an injectable local anesthetic, prior to injection into the skin. This approval was based on a large study of patients, in which 100% of patients reported feeling less pain when Radiesse was pre-mixed with lidocaine. Many plastic surgeons, including me, have begun to pre-mix lidocaine with all fillers, including Juvederm, Restylane, and Evolence, not to mention Radiesse, prior to injecting into patients. The results of treatment are still great, but patients are significantly more comfortable during treatment.
Others things your plastic surgeon can do to make your treatment with injectable fillers more comfortable include:
• Using topical anesthetic gel for at least 30 minutes prior to commencing any injections.
• Augmenting treatment with topical anesthetic gel with injections of local anesthetic into nerves above and below the lips.
• Using small gauge needles and slow injection techniques
Combining all of these treatments can ensure that you’ll not only look great after your treatment with injectable fillers, but you’ll feel pretty great during the treatment too!